Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.

We investigated the prevalence and genetic variation of porcine pseudorabies virus(PRV)in Hunan Province.A total of 18 861 serum samples and 1 725 suspected PRV-infected tissue sam-ples were collected from Hunan Province from 2021 to 2022.ELISA and qPCR assays were used to detect PRV-gE antibodies in serum samples and the PRV-gE nucleic acids in tissue samples.The positive rates of samples in different years and seasons were analyzed correspondingly.Moreover,the gC gene sequences of 15 PRV-positive samples were amplified,sequenced,and analyzed.The results showed that 2 004 serum and 56 tissue samples tested positive,with an average positive rate of 10.74％and 3.25％,respectively.The sequence analysis showed that the nucleotide and ami-no acid sequence identities of the gC gene among 15 PRV-positive samples were 98.4％-100.0％and 98.8％-100.0％,respectively.Further genetic evolution analysis showed that 13 PRV strains belonged to the same branch with the PRV variants,while two strains were clustered into the same branch with the classical PRV strains.The above results indicate that PRV remains widely prevalent in different regions of Hunan Province,and the variant strain is the dominant epi-demic subtype,which provided a scientific basis for exploring the epidemiological characteristics of PRV and the development of vaccines against PR in Hunan Province.

【Objective】 To investigate the efficacy of flexible ureteroscopic holmium laser lithotripsy combined with cyst wall incision and drainage in the treatment of renal calculi with ipsilateral renal cyst. 【Methods】 A total of 70 patients with renal calculi complicated with ipsilateral renal cyst (cyst diameter >40 mm, maximum diameter of stone <20 mm, distance from renal calyx <2 mm) treated in our hospital during Feb.2015 and Feb.2020 were selected. The patients were divided into cyst wall incision and drainage group (flexible ureteroscopic holmium laser lithotripsy combined with cyst wall incision and drainage) and renal cyst deroof decompression group (flexible ureteroscopic holmium laser lithotripsy combined with retroperitoneal laparoscopic renal cyst unroofing decompression), with 35 cases in either group. The general information, clinical data, complications, stone-clearance rate and 12-month postoperative effective rate were compared between the two groups. 【Results】 All operations were successful. Compared with the renal cyst unroofing decompression group, the cyst wall incision and drainage group had shorter operation time and postoperative hospital stay (P<0.05), lower postoperative Scr[(107.61±16.88) μmol/L vs. (138.25±18.29) μmol/L, P<0.05], higher Hb[(124.33±12.85) g/L vs. (101.36±13.14) g/L, P<0.001], lower incidence of complications (8.6% vs. 28.6%, P=0.031). There were no significant differences in the residual stone rate and effective rate between the two groups 12 months after operation (P>0.05). 【Conclusion】 Flexible ureteroscopic holmium laser lithotripsy combined with cyst incision and drainage has the advantages of short operation time, small trauma, few adverse reactions, good stone clearance effect and satisfactory efficacy. It can be used as a preferred surgical method for renal calculi complicated with ipsilateral renal cyst.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

Objective:To investigate the correlation between plasma microRNA (miR)-122, miR-33a and the severity of coronary artery disease in patients with type 2 diabetes mellitus (T2DM) and coronary heart disease.Methods:The clinical data of 196 patients with T2DM from January 2019 to October 2021 in Xuzhou First People′s Hospital were retrospectively analyzed. Among them, 81 cases were complicated with coronary heart disease (combined group), 115 cases were not complicated with coronary heart disease (control group). The plasma levels of miR-122 and miR-33a were detected by real-time fluorescence quantitative reverse transcription polymerase chain reaction, the plasma level of N-terminal B-type natriuretic peptide precursor (NT-proBNP) was detected by enzyme-linked immunosorbent assay. In combined group, the number of coronary artery lesions was determined according to the results of coronary angiography, and Gensini score was evaluated. Linear regression model was used to analyze the relationship between plasma miR-122, miR-33a and NT-proBNP levels with the incidence of coronary heart disease in patients with T2DM. Receiver operating characteristic (ROC) curve was used to analyze the plasma miR-122 and miR-33a in predicting efficiency of coronary heart disease in patients with T2DM. In combined group, Spearman correlation method was used to analyze the relationship between plasma miR-122, miR-33a and the number of coronary artery lesions, and Pearson correlation method was used to analyze the relationship between plasma miR-122, miR-33a and plasma NT proBNP, Gensini score.Results:The plasma miR-122, miR-33a and NT-proBNP in combined group were significantly higher than those in control group: 5.76 ± 1.35 vs. 1.18 ± 0.33, 1.39 ± 0.37 vs. 0.65 ± 0.11 and (786.87 ± 156.39) ng/L vs. (103.45 ± 19.27) ng/L respectively, and there were statistical differences ( P<0.01). Linear regression result showed that plasma miR-122, miR-33a, and NT-proBNP were positive correlation with occurrence of coronary heart disease in patients with T2DM ( P<0.01); ROC curve analysis result showed that the area under curve of plasma miR-122, miR-33a and combination in predicting coronary heart disease in patients with T2DM were 0.816, 0.845 and 0.912 respectively (95% CI 0.744 to 0.865, 0.768 to 0.892 and 0.836 to 0.967). Coronary angiography result showed that there were 46 cases of single vessel lesions, 25 cases of double vessel lesions and 10 cases of three vessel lesions. The plasma miR-122, miR-33a, NT-proBNP and Gensini score in patients with three vessel lesions were significantly higher than those in patients with double vessel lesions and patients with single vessel lesions: 6.52 ± 0.96 vs. 4.95 ± 0.85 and 3.74 ± 0.52, 1.45 ± 0.31 vs. 1.06 ± 0.25 and 0.81 ± 0.13, (829.78 ± 62.59) ng/L vs. (627.48 ± 47.12) and (502.64 ± 38.24) ng/L, (63.89 ± 12.71) scores vs. (42.18 ± 6.03) and (22.36 ± 2.41) scores, the indexes in patients with double vessel lesions were significantly higher than those in patients with single vessel lesions, and there were statistical differences ( P<0.05). In combined group, Spearman correlation analysis result showed that the plasma miR-122 and miR-33a were positive correlation with the number of coronary artery lesions ( r = 0.879 and 0.825, P<0.05); Pearson correlation analysis result showed that the plasma miR-122 and miR-33a were positive correlation with the plasma NT-proBNP and Gensini score (miR-122: r = 0.896 and 0.788, miR-33a: r = 0.871 and 0.765; P<0.05). Conclusions:The plasma levels of miR-122 and miR-33a are related to the occurrence of coronary heart disease and severity of coronary artery disease in patients with T2DM, which may be used to guide the prevention and treatment of coronary heart disease in patients with T2DM.

Gene editing tools with nucleases as the main component have now implemented programmable targeted mutagenesis or insertion or deletion of mammalian genomes.From zinc finger nucleases (ZFNs), transcription activator-like effector nucleases (TALENs), CRISPR/Cas system to safer and more accurate Cas9 fusion protein gene editing tools and other nuclease gene editing tools, this paper systematically describes the development and evolution of gene editing, with detailed introduction to the development and optimization of next-generation gene editing tools, and a prospect of the clinical application of and challenges for gene editing tools.

Objective:To study the effect and safety of endoscopic ultrasonography guided reverse dissection for refractory benign esophageal stricture.Methods:Seventeen patients with refractory benign esophageal stricture were selected for endoscopic ultrasonography guided reverse dissection in Shunde Hospital, Southern Medical University from January 2016 to December 2019. The clinical data including operation success rate, complications and clinical efficacy were analyzed.Results:All 17 patients were successfully treated with endoscopic ultrasonography guided reverse dissection. The operating time was 38.82±24.27 minutes. No serious complications such as major bleeding, perforation, and infection were found during and after the operation. The follow-up time ranged from 3 to 44 months. Four patients had symptoms of dysphagia again at 3, 12, 18, and 26 months after operation, and re-examination of gastroscopy revealed recurrent esophageal stenosis. The rest of the patients did not re-stenosis until the last time of follow-up.Conclusion:Endoscopic ultrasonography guided reverse dissection is a safe and effective treatment for refractory benign esophageal stricture.

Objective To investigate the anti-tumor activity of triterpenoids from Ganoderma lucidum on different tumor cells . Methods The MTT assay was adopted to detect the in vitro inhibition effect on 5 kinds of tumor cells .The inhibiting curve was drawn ,IC50 was calculated for reflecting the compound′s cytotoxic activity .Results The in vitro experiments demonstrated that three kinds of triterpenoids compound monomer showed different degrees of inhibition effect ,in which the inhibitory effect of gano-derenic acid Y was stronger ,its IC50 on H460 lung cancer cells was 22 .4 μmol/L ,followed by 7-oxo-ganoderic acid Z2 ,its IC50 was 43 .1 μmol/L .Conclusion Ganoderenic acid Y shows a strong inhibitory activity on H 460 lung cancer cells ,7-oxo-ganoderic acid Z2 shows a certain inhibitory activity on H 460 lung cancer cells ,moreover the inhibitory activity is dose dependent .The three com-pounds of ganoderenic acid Y ,7-oxo-ganoderic acid Z2 and ganoderon B have no activity or very weak activity to the other detected cell lines .The anti-lung cancer activity of ganoderenic acid Y and 7-oxo-ganoderic acid Z2 needs to be further deeply studied .

Objective To observe the effect of costimulatory molecule B7-1 on cytoskeleton rearrangement in mouse podocytes induced by angiotensin Ⅱ (Ang Ⅱ),and to study the underlying molecular mechanism of B7-1 in the pathological changes of podocytes.Methods All cultivation of conditionally immortalized mouse podocytes (MPC) in vitro were divided into the following groups:normal control group,CTLA-4 group,Ang Ⅱ group (10-6 mmol/L 12 h,24 h;10-8 mmol/L 12 h,24 h) and CTLA-4 with Ang Ⅱ group.Transfect B7-1 RNA interference fragment (siRNA) to the mature podocytes,and then restimulated by Ang Ⅱ (10-6 mmol/L 12 h),the change of podocyte cytoskeleton after Ang Ⅱ stimulation were observed.The expression of B7-1 in each group was assayed by flow cytometry and Western blotting.The nephrin and p-nephrin protein levels in the four groups were also analyzed by Western blotting.At the same time,the podocyte cytoskeleton distribution as indicated by F-actin was observed by fluorescence microscopy.Results Flow cytometry and Western blotting showed that B7-1 was not expressed in the normal control group.Ang Ⅱ showed a concentration and time dependent induction of B7-1 expression in mouse podocytes (P ＜ 0.05).Western blotting indicated that Ang Ⅱ induced B7-1 protein expression (P ＜ 0.05).Expression of nephrin and p-nephrin was significantly down-regulated by Ang Ⅱ (P ＜ 0.05).Compared with the normal control group,the expression of podocyte protein nephrin and p-nephrin in Ang Ⅱ stimulation group was significantly reduced (P ＜ 0.05).Using FITC phalloidin fluorescence staining showed that CTLA-4+Ang Ⅱ stimulation group cytoskeleton rearrangement was improved significantly and F-actin recombinant score (mCFS) decreased compared with Ang Ⅱ group (P ＜ 0.05),suggesting that Ang Ⅱ led to the disorder of the podocytes cytoskeleton and the destruction of the cytoskeleton of podocytes by Ang Ⅱ could be improved after B7-1 blocking.Compared with the Ang Ⅱ stimulation,transfection of B7-1 siRNA + Ang Ⅱ stimulation group improved F-actin cytoskeletal rearrangement,and mCFS also decreased significantly (P ＜ 0.05),suggesting that transfection of B7-1 siRNA might improve the damage of Ang Ⅱ on podocytes cytoskeleton.Conclusions B7-1 participates in the process of cytoskeleton reconstruction and plays an important role in the pathological changes of podocytes.

Objective To study the clinical effect of peritoneal and abdominal indwelling tube by ultrasound for patients with severe acute pancreatitis.Methods Sixty-eight patients with severe acute pancreatitis from January 2010 to December 2013 were analyzed retrospectively.The patients were divided into experiment group (48 cases) and control group (20 cases).The patients in control group were given the common drugs treatment,and the patients in experiment group were given the common drugs and the peritoneal and abdominal indwelling tube by ultrasound.The clinical effects and complication were compared.Results The total efficacy rate in experiment group was 93.75％(45/48),in control group was 35.00％(7/20),and there was significant difference (P ＜ 0.05).Seven patients in experiment group occurred complication,after the symptomatic treatment 6 patients recovered and 1 patient died of multiple organ failure;7 patients in control group occurred complication,after the symptomatic treatment 3 patients recovered and 4 patitents died of infection recurrence.The complication rate in experiment group was 14.58％(7/48),in control group was 35.00％ (7/20),and there was significant difference (P ＜ 0.05).Conclusion Peritoneal and abdominal indwelling tube by ultrasound could improve clinical efficacy and decrease complication rate for patients with severe acute pancreatitis.